PIH3 Pregnancy Outcomes Folowing Exposure to Serotonin Reuptake Inhibitors: A Meta-Analysis

Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Reproductive Toxicology (Impact Factor: 2.77). 12/2006; 22(4):571-5. DOI: 10.1016/j.reprotox.2006.03.019
Source: PubMed

ABSTRACT Serotonin reuptake inhibitors (SRIs) are extensively used in management of clinical depression. Reports vary about the risk of these drugs during pregnancy. To determine the risk of exposure to SRIs, we pooled data from multiple clinical studies that investigated obstetrical outcomes in women exposed to this group of drugs during pregnancy. Studies were identified by search of PUBMED, OVID, and SCOPUS databases and the data were derived from 1990 to 2005 (August). Types of outcome investigated were spontaneous abortion, major malformations, cardiovascular malformations, and minor malformations. The criteria for inclusion of studies in this meta-analysis were exposure of women to any therapeutic dosage of SRI (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) during pregnancy. Our results find that SRIs do not increase the risk of major, cardiovascular and minor malformations but do increase the risk of spontaneous abortion significantly.

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Available from: Mohammad Abdollahi, Dec 31, 2014
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    • "However, there are no published accounts of a meta-analysis that directly compares the teratogentic potential of common individual SSRIs that might indicate which are comparatively safer. Previous studies have reported the teratogenicity of SSRIs as a medication class (Rahimi and Abdollahi, 2006) or have examined aggregates of newer antidepressants agents (including reboxetine, venlafaxine, and bupropion ) (Einarson and Einarson, 2005). These studies might be of limited value to patients and clinicians because the teratogenic potential of specific agents might differ from the aggregate result for SSRI or non-SSRI medications as a class. "
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    ABSTRACT: Context:It has been suggested that the commonly prescribed class of antidepressants selective serotonin reuptake inhibitors (SSRIs) are associated with birth defects. However, the teratogenic effect of individual SSRIs has not been previously compared using meta-analysis.Objective:To determine the strength of the association between individual SSRIs and major, minor, and cardiac malformation among infants born to women taking these medications.Data sources:Electronic search of CINAHL, EMBASE, Medline, PsycINFO, and ISI Web of Science using the search terms (SSRI OR antidepressant) AND (obstetric outcome OR malformation OR birth outcome OR teratogen), supplemented by manual searching of published references and requests of primary researchers for unpublished data.Study selection:There were 115 studies identified by electronic search and reviewed in full text, which yielded 16 papers reporting 36 data samples for major malformations, nine papers reporting 26 data samples for cardiac malformations, and four papers reporting seven data samples for minor malformations.Data synthesis:Fluoxetine (OR 1.14, 95% CI 1.01-1.30) and paroxetine (OR 1.29, 95% CI 1.11-1.49) were associated with increased risk of major malformations. Paroxetine was associated with increased risk of cardiac malformations (OR 1.44, 95% CI 1.12-1.86). Sertraline and citalopram were not significantly associated with congenital malformation. Between-sample heterogeneity was low and a range of methodological considerations had no significant impact on effect size. There was little evidence of publication bias.Conclusions:Fluoxetine and paroxetine should be avoided in the first trimester and among those at risk of an unplanned pregnancy.
    Australian and New Zealand Journal of Psychiatry 06/2013; 47(11). DOI:10.1177/0004867413492219 · 3.77 Impact Factor
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    • "They note increased rates of spontaneous abortions in patients taking antidepressants but suggest that this issue may be confounded by the presence of depression and that therefore the apparent increase has not been shown to be caused by antidepressants. On the issue of possible teratogenicity, citing several reviews [20] [40], they state " there is limited evidence of teratogenic effects from antidepressants during pregnancy. Demonstrated statistical association in a cohort study does not support a judgement of causality " . "
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    ABSTRACT: In recent years, a number of authors have advocated the merits of conducting randomised controlled trials (RCTs) of antidepressants in women with nervous disorders during the prenatal period. However, a critical review of the literature indicates RCTs are not justifiable. At a time when it has become clear that a significant proportion of the existing literature on the use of pharmaceutical agents is ghostwritten, ethicists and others making assertions that RCTs are needed risk becoming part of an apparatus that plays down the hazards of treatment and promotes the use of treatments that may be harmful.
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